Welcome! Welcome to our 8th meeting together. I am so glad that you have joined me again. Today we are going to talk about why it is so important to take care of our feet. We will also do some hands-on activities that may helpful. Before we hear what Uncle Tommy and Kaipo are doing today, let’s talk a moment about how diabetes can affect our feet. We rely on our feet to take us along the path to strength, health, and long life. Sometimes we take them for granted though. We need to take care of them so they can last a lifetime. Diabetes can cause foot problems in two ways:

1. Nerve damage – one problem can be damage to nerves in your legs and feet. With damaged nerves, you might not feel pain, heat, or cold. A sore or cut on your foot may get worse because you do not know it is there. This lack of feeling is caused by nerve damage, also called diabetic neuropathy. Nerve damage can lead to a sore or an infection.

2. Poor circulation – The second problem happens when

not enough blood flows to your legs and feet. Poor blood flow makes it hard for a sore or infection to heal. This problem is called peripheral vascular disease. Smoking when you have diabetes makes blood flow problems much worse.

These two problems can work together to cause a foot problems.

Healthy Feet Keep You Going! Meeting 8

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Uncle Tommy knows how important it is to take care of his feet. Let’s hear how Uncle Tommy keeps his feet healthy to take him along the path to strength, health and long life.

Today is a beautiful day, Uncle Tommy thought to himself as he was getting dressed. “I think today is a good day to walk to the store and get some things I need. Maybe Kaipo will be able to go with me,” Uncle said to his wife as he was putting on his socks and shoes.

Auntie Nani gave him a pat on his shoulder and said, “That’s a good idea, and when you get back, I’ll have some lunch ready for the two of you. By the way, don’t forget to check your feet before you put your socks and shoes on, okay?” Uncle smiled and thanked her for the reminder. He carefully checked his feet for sores, cracks and anything unusual. He put his socks on but as he started to put his shoes on, he found a rock in his shoe. “Look! I found a rock in my shoe and that could have really hurt my foot! Alright, now I’m ready to go, so I will see you later.” Uncle said.

Uncle Tommy walked down the street to Kaipo’s house. Kaipo was happy to go with Uncle Tommy. “Where are we going?” he asked Uncle. “I have to go to the store and I wanted your company,” Uncle said. “Great! Can Skip go with us too?" asked Kaipo. “Sure! Skip needs the exercise too!” laughed Uncle.

4-4 8-2

Along the way, Skip started to limp. Kaipo noticed that Skip was having a hard time keeping up with him and Uncle. “Uncle, I think Skip is hurt,” said Kaipo. “He must have a splinter or a rock in his paw. Let’s stop and check,” replied Uncle Tommy. Kaipo watched Uncle Tommy gently lift the dog’s paw and look at it. He noticed a small rock and removed it. “There you go, Skip, good as new!” Uncle said as he patted the dog.

“I almost had that same problem this morning,” Uncle laughed. “You know, Kaipo, it’s good that we took care of Skip’s paw. He is way too big and heavy for us to have to carry around.”

“We need to make sure that his paws are taken care of, just like I have to check my feet every day because of my diabetes. I have to make sure I don’t have things in my socks or shoes that can make me limp like Skip. People with diabetes have to be especially careful because sometimes they can lose feeling in their feet. I want to take care of my feet so I can go places and do things with you,” said Uncle. “Good, because I have some new soccer moves to show you when we get back home!” smiled Kaipo. Uncle Tommy enjoys being active. He realizes that taking care of his feet is another important thing he has to work on because of his diabetes.

8-3

Feet Can Last a Lifetime!

Did you know that your feet should last a lifetime? Keeping your glucose in balance can help your feet stay healthy. This is the first step in taking care of your feet. If glucose is not in balance, it can cause poor blood flow to the feet, and this can keep sores from healing. Foot sores can lead to infections that may cause the loss of a toe or a foot.

Feet must be healthy to do all that they have to do. The feet are usually very sensitive. We should be able to know when our feet are hurting, when it is time to fix our socks, or change our shoes. We should also be able to tell if we have a rock in our shoe, how soft a carpet is under our feet, or to feel the touch and the tickle from someone playing with our toes. But when a person has had diabetes for a long time, they sometimes have very little, or no feeling, in their feet. This happens because of nerve damage. Having high blood glucose for a long time causes nerve damage.

Healthy Feet Keep You Going! Meeting 8

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What things can you do to keep your feet healthy?

One way to keep feet healthy is to wash your feet in warm water every day:

Make sure the water is not too hot. Do not soak your feet. Soaking dries your skin and

can lead to infections. Dry your feet well especially between your toes.

If your skin is dry, rub lotion on your feet after you

wash them. Do not put lotion between your toes. Another way to keep feet healthy is to check your feet every day: If you are at home and need help, ask a family member to help you. Check your feet:

- In the morning before you put on socks and shoes, - In the evening before bed when you take your socks

and shoes off. Once you get into the habit of doing this, it won’t seem like it takes so long. Remember, you are doing this to protect your feet from any serious problems.

Meeting 8 Healthy Feet

Keep You Going!

8-5

Wash Feet in Warm Water

Every day!

Check your feet every day!

Here’s how you can check your feet:

♦ Hold a mirror at an angle so that you can see your foot as you look into the mirror.

♦ Look at both sides of each foot, and at the bottom of the each foot.

♦ Always check the top and bottom of each foot too.

♦ Check between toes for cuts, scratches, red spots, blisters or signs of an infection.

If you cannot bend over or bring your feet up to check them yourself, it is still important to know how to check your feet so that you can tell someone in your family how to do it the right way for you. When checking feet, you are looking for:

• Any cuts, scratches, red spots, or blisters • Any corns or calluses • Any ingrown toenails • Any change in the color of the feet • Checking for any sign of infection Signs and symptoms of an infection are:

• Redness • Swelling • Pain • Warmth in the area • Green or yellow pus draining from the area

Meeting 8 Healthy Feet

Keep You Going!

8-6

Checking your feet!

What to look for

What do you do if you see a change, or find a problem with your feet?

Call or go see your provider that same day if you have a sore that is red, swollen, painful, or if there is oozing from the sore. Problems can get worse very fast. It is important that you have the problem taken care of right away.

Do not wait to see if it will get better. Do not try to take care of it yourself. See your provider right away. Other things to stay away from to keep feet healthy: Heating pads or hot water bottles because these

may burn feet, Iodine on feet,

Corn removal medicine of any kind,

Razor blades, and Walking barefoot - always wear shoes and socks!

Meeting 8 Healthy Feet

Keep You Going!

8-7

What do you do if you have a

foot problem?

Knowing how to trim your toenails the right way is another important part of taking care of your feet. If you are not having any serious problems with your feet, you can trim your own toenails. Toenails are softer and easier to trim after you have washed and dried your feet. Trim toenails straight across and smooth rough edges with a nail file. If you do not feel things very well with your feet or have nails that are hard to trim, it is best to have your toenails trimmed by your provider or someone from the diabetes team. Only a trained person should cut the toenails of a person with diabetes. Some clinics may have a podiatrist that is scheduled to be there at certain times of the month. If your clinic has a podiatrist, make an appointment to see him/her. A podiatrist can trim toenails, do foot exams, and can take care of any foot problems that you may have. There is another part of a foot check that I would like to show you. It is called the monofilament exam. The doctor does this to see how much feeling, or protective sensation, you have in your feet. Let’s look at the monofilament. You may have seen this before at the clinic when your provider checked your feet. The monofilament is made of something like fishing line. Test the monofilament on the palm of your hand so you can see how it feels and bends when it touches your skin. Let’s take our shoes and socks off and try the test. You can either do the test on yourself, or get a partner.

Meeting 8 Healthy Feet

Keep You Going!

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Trimming your toenails

See a Podiatrist

The Monofilament

Exam

1. Hold the monofilament by the handle

2. Use a smooth motion to touch the filament to the skin on your foot. DO NOT touch a sore or callus with the monofilament. Touch to the side of a sore or callus. Touch the filament to your skin for 1-2 seconds. Push hard enough to make the filament bend as shown in step 2. 3. Touch the filament on both of your feet in the sites circled on the drawing below, or on the next page.

4. Place a (+) in the circle if you can feel the filament at that site and a (-) if you cannot feel the filament at that site.

5. The filament is reusable. After use, wipe with an alcohol swab.

Left Right

8-9

Left Right

If you have a (-) in any circle, take this form to your health care provider as soon as possible. Date

Protect Your Feet!

Healthy Feet Keep You Going! Meeting 8

If you find places on your feet where you do not feel the monofilament, this is an important sign. It is telling you that you need to be careful with your feet. Your feet will not be able to let you know if there is a problem, so you need to check your feet everyday. Be careful to protect your feet at all times. Another thing you can do to protect your feet if you have lost feeling is to wear protective shoes. Your provider or podiatrist can prescribe special protective shoes, or shoe inserts for you. Medicare and other health insurance programs may pay for special shoes. It is important to wear the protective shoes, or shoe inserts, if you need them. Your provider should check your feet with a monofilament at least once a year. Your feet should also be checked every time you go to the clinic, so take off your shoes and socks before the doctor comes in. If your provider asks you, “Why do you have your shoes and socks off?” You can tell him/her that you want to keep your feet healthy so they need to check your feet.

8-10

When do I get my feet

checked?

Many times people buy shoes because of the way they look, and not because they are good for the feet. To have healthy, happy feet, you need to be aware of several things when buying shoes: 1. The shoes need to be wide enough so that your

toes can wiggle in them when you are standing.

2. Athletic, cross-trainer, and walking shoes made of canvas or leather are good for daily wear. They support your feet and allow them to breathe.

3. Avoid vinyl or plastic shoes because they don’t stretch or breathe.

4. Buy shoes with rounded toes, with laces or velcro straps, soft soles, and soft insides.

5. Try to buy your shoes in the afternoon after you have been on your feet for a while.

6. Shoes should not be tight or put pressure on any spot. Remember – if you cannot feel the monofilament in all the spots, you won’t be able to feel if the shoe fits right. You need to look for shoes that will be good for your feet.

There is a pamphlet “Does the Shoe Fit” in the pocket that gives you more tips for buying healthy footwear. Take time to read it before you buy your next pair of shoes.

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Let’s review what we have talked about today:

Feet can last a lifetime Check your feet every day Always have your toenails trimmed straight across Wear shoes and socks everyday - never walk

barefoot Have your provider check your feet at every clinic

visit Contact your provider right away if you find a

problem with your feet Just as Uncle Tommy checks his feet everyday to keep them healthy, you need keep your feet healthy so that you will have them for a lifetime to carry you along the path to strength, health, and long life.

Take a few minutes now to write down one goal that you plan to work on this week to keep your feet healthy. Remember all that we talked about today.

Thank you for coming today and I look forward to seeing you at our next meeting when we will talk about stress, depression, and diabetes. Don’t forget to bring your notebook.

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Let’s Review

Set a Goal!

Thank you!

Meeting 8 Healthy Feet

Keep You Going!

We appreciate that you have taken the time to be with us. Before you leave, please take a few minutes to give us your thoughts about today’s meeting.

1. As you were going through today’s meeting, what information did you find especially helpful to you?

2. What goal did you set for yourself? 3. Are there any other comments about today’s meeting that you would like

to share with us?

Thank you!

Meeting 8

Review of Meetings 1-7, Questions, Dictionary, Brochures

How can my doctor help me take care of my feet? Here are some ways your doctor can help you take care of your feet. Your provider will be happy to answer your questions and work with you as a partner in your health care.

1. Tell your doctor right away about ANY foot problems.

2. Your doctor should do a complete food exam with the monofilament every year.

3. Ask your doctor to look at your feet at each diabetes checkup. Take off

your shoes and socks before the doctor comes in.

4. Ask your doctor to check how well the nerves in your feet sense feeling.

5. Ask your doctor to check how well blood is flowing to your legs and

feet.

6. Ask your doctor to show you the best way to trim your toenails. Ask what lotion or cream to use on your legs and feet.

7. If you cannot cut your toenails or you have a foot problem, ask your

doctor to send you to a foot doctor (podiatrist).

8. Ask the doctor if the monofilament test found any places on your feet that you do not feel.

9. Ask the doctor when he/she last checked your feet with the

monofilament.

Dictionary Meeting 8: Healthy Feet Keep You Going!

Term Meaning of the Term

Amputation Surgical removal of a diseased body part, limb, or body organ.

Callus A small area of skin, usually on the foot, that has become thick and hard from rubbing or pressure. Calluses may lead to other problems such as serious infection. Shoes that fit well can keep calluses from forming.

Edema Swelling or puffiness of some part of the body such as the ankles.

Gangrene Tissue death; Gangrene can cause the skin tissue to turn black and die. This can lead to amputation of the toes or foot.

High Risk Feet Feet with loss of protective sensation, deformity, calluses, foot ulcers, or history of foot ulcers.

Ingrown nails Toenails whose corners or sides dig painfully into the skin.

Monofilament Exam An exam that tests the feelings, or protective sensation, of feet.

Neuropathy Nerve damage caused by high glucose (sugar). People with nerve damage may lose feeling in their feet and hands.

Peripheral neuropathy

Most common type of neuropathy in people with diabetes. People may feel numbness, tingling, or pain in the feet, legs, hands, and arms.

Peripheral Vascular Disease

Poor blood flow to legs and feet making it hard for sores or infections to heal.

Podiatrist A physician who treats foot problems.

Ulcer A foot ulcer is a hole through the skin on the foot. It may go all the way to the bone or not be very deep.